Provider Demographics
NPI:1104858711
Name:GONZALEZ, PENELOPE (MD)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 BISSONNET ST 736
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1451
Mailing Address - Country:US
Mailing Address - Phone:713-980-5461
Mailing Address - Fax:
Practice Address - Street 1:2429 BISSONNET ST 736
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1451
Practice Address - Country:US
Practice Address - Phone:713-980-5461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH79204Medicare UPIN
TX8F5276Medicare PIN